CT引导经腹穿刺腰椎间盘切吸溶核术(附138例分析)

目的探索对L3-4、L4-5、l5-S1椎间盘膨/突出和突出并迁移的介入微创治疗新途径。方法通过对人体解剖及正常人模拟试验和CT影像对照研究,行靶椎间盘平面腹部压迫,经压迫定位器穿刺椎间盘,建立手术通道行椎间盘切吸溶核术。138例患者行CT引导经腹穿刺腰椎间盘切吸溶核术(TALD)。结果按日本骨科学会腰背痛手术评分标准,以治疗前后的分值计算改善率,〉90%为优,112例占89.5%;改善率〉80%为良好,26例占10.5%。优良率100%。结论CT引导下TALD可多角度直接钳取髓核组织或穿过纤维环侧后缘钳取椎管和椎间孔之迁移椎间盘组织,对椎管内残留少量髓核行胶原酶溶核。具有操作简单、安全可靠、疗效高、创伤小、恢复快等特点,是治疗腰椎间盘膨/突出症理想根治手段。

CT guided transabdominal lumbar diskectomy and nucleus pulposus dissolving (A report of 138 cases)

Objective To explore a new method of treatment TALD for L3-4?L4-5?L5-S1 lumbar disk herniation or protrusion for shifting the indication of intervention treatment,with a report of 138 cases. Methods To studiy the anatomy of human and abnormal huamn simulated experiment and compared with image of CT,pressure on the abadominal puncture at the level of lumbar disk. Translaparopuncture lumbar disk ,to create a passage for intervertebral disc dissecting and aspirating the nucleus pulposus dissoloving.CT guided TALD was used in 138 patients. Results According to the standard grading of the Japanese osteology, the percent of improvement>90% is best,112 cases(89.5%),>80% is better,26 cases(10.5%),effective percent is 100%. Conclusion CT guided TALD can be managed in various angles to take nucleus pulposus during surgery or through the fiberous ring,spinal canal and the shifting of intervertebral foramen can be treated and disc tissue also can be taken,disslove nucleus pulposus left in the spinal canal with collagenase. It is saftey and effective ,and quikly recovery. It is a cure method to treat lumbar disk herniation or protrusion.